Botox Vs Fillers: Here’s Everything You Need To Know

Botox vs Fillers, which is right for you? Botox and Fillers are no strangers in aesthetic fields to help men and women gain confidence in their appearance. What's the difference between the two treatments? Today, we have Dr Steve Chia from Sliq Clinic to explain to us.

GetDoc: To set the stage, could you give a brief overview of the different filler types and their modes of action?

Dr Steve: It’s important to differentiate the injectables. Under filler group we have collagen stimulatory fillers and non-collagen stimulating filler. The non-stimulatory fillers is hyaluronic acid (HA) fillers, this is by far the most common type of filler used due to its safety profile and reversibility. Then we have the collagen-stimulatory fillers, such as poly-L-lactic acid, calcium hydroxylapatite and Polycaprolactone, these filler has longer lasting result due to its biostimulatory feature. There is permanent filler but they are not commonly used in the market.

Dr Steve: Botox is brand name for Botulinum toxin type A. It is commonly used to reduce facial wrinkles, as it can relax the muscles, resulting in the smoothing of the overlying skin and reduction of fine lines. Patients normally can see the result within 5 days after the injection. Each treatment can have effect lasts 4 to 6 months, hence patient can opt to repeat twice a year for best result. Other than cosmetic usage, Botox is also used to treat excessive sweating over armpit and palm area, or and also used to reshape the masseter of our jawline to make a smaller V shape face. Other indication includes calf muscle hypertrophy and bruxism (jaw grinding).

GetDoc: What is filler?

Dr Steve: Dermal fillers are a naturally-derived or synthetic material that is directly injected into skin. It is commonly used to fill the face, very deep wrinkles, sunken face, plumping that area to the point where the wrinkle or fold is gone. There are several types of fillers, and ingredient used is very different. 20 years ago, filler was started with silicone injection which is commonly used by plastic surgeons. Silicone was then banned because it causes complications such as filler migration, infections and skin cancer.

Nowadays, the filler you find in the market are usually temporary, they are safe as they are dissolved by our body. Personally, I do not recommend permanent filler to my patients as the result can only be reversed through surgery. The most commonly used are the hyaluronic acid filler such as Juvederm, Teosyal or Restylane. These fillers are suitable for first time patient as its totally reversible. If patients don't like the result of the filler, we can dissolve them without surgery. The result is very natural as well. It gives an option for the patient as they do not have to worry about its permanency.

GetDoc: What’s the difference between Botox and filler?

Dr Steve: In Malaysia, people prefer filler than Botox. There is a misconception that Botox is only for old or aging people. Some even thought that it is poisonous as they are afraid of the word toxin and Chinese direct translation is poison. Actually, patients shouldn't be worried much, Botulinum toxin is used in hospitals to to treat condition like muscle spasm and in eye treatment like squint. They were then used cosmetically to treat lines over the forehead and was found to be effective as well. It relaxes the muscle over treated area and it has short period of action and typically last 4-6 months, so it does not have any long term side effect.

As compared to Botox, filler is used as it has plumping smoothing effect to treat sunken area due to aging like the under eye area, or cheek area. Its also used to improve facial features such as plumping up the lips, or injected to create higher nose bridge or sharper chin.

As these two treatments are giving different results, hence patients may need both Botox and dermal fillers procedures to achieve more natural result.

GetDoc: Botox and Filler, are they painful?

Dr Steve: If you ask me, the most painful treatment is probably actually Ablative Laser, not injection treatment like Botox and filler. Botox and dermal filler procedures are quite established in aesthetic industry. Aesthetic doctors usually will use tiny needles that is not used in normal hospital setting to minimize bruises and discomfort. Usually the treatment takes around 15 minutes or less to complete. Although injection does sound scary, but you won’t feel a thing during the treatment as we will apply numbing cream prior to treatment.

Injection is less painful than laser. (Source from Facialworks.com)

GetDoc: Who is more suitable for filler treatment?

Dr Steve: For those who don’t want to go under the knife and look dramatically different, they are suitable for this treatment.

For patients in their 20s, they usually opt this treatment for lip plumping, facial enhancement, smaller or higher nose, v shape face, sharper chin.

For patients in their 30s or 40s, they have aging problem, for example sunken or flat cheek, sunken temples or forehead, under eye or tired eyes problem. Filler can help them with all these aging problems.

Some patients will use fillers on their hands. Back of the hand are full veins or the skin is sunken, filler can help those areas to look ‘full and hydrated’.

For filler, you can see immediate and natural result. Swelling and bruises is rare and usually will go one week after the treatment. That being said, I will advise patients not to do any injection within one week of any important event.

GetDoc: Are there different types of patients for whom specific fillers are best?

Dr Steve: Different type of filler can have different result. Even in the Hyaluronic acid group we have may different type of filler suitable for different area of treatment. its best to get consultation from your treating doctor and discuss the best product for your skin. Its always fine to ask to see before after pictures of patient who has undergone the same treatment, so that you can gauge the possible outcome and if you like what you see, then go ahead and sign up for the treatment. I do not advise patient who has previous unknown filler injection or previous surgery to do filler treatment as it carries higher risk of complications such as infection and skin necrosis.

The before and after filler treatment (Source from DrKotlus.com)

GetDoc: Are both treatments suitable for every skin type?

Dr Steve: Yes, Botox and filler are universal for any skin type.

GetDoc: Botox vs Fillers, what are the side effects of Botox?

Dr Steve: It is considered safe procedure, if performed in an approved clinical setting by certified aesthetic personnel. Side effects from the procedure can be pain at injection site, bleeding or bruising. In some cases of over injection or incorrect placement of product over the forehead lines, it may can droopy or heavy upper eyelids that are temporary. Usually it will last a few weeks. Again to emphasize this point again, due to its reversibility, it has no long term side effect.

GetDoc: Botox vs Fillers, what are the side effects of Filler?

Dr Steve: Injection technique and skill of the doctor is important to achieve good result for filler injection. As for injection related side effect includes bleeding or bruising, swelling which is temporary. Incorrect placement of filler into blood vessels can cause tissue or skin necrosis. Also reaction or allergy due to product itself is possible. It is important to talk to your doctor and voice our your concern, discuss different type of treatment and approach to achieve the result that you want. Find a doctor you trust, do your part to research about patients satisfaction of the product used before doing any treatment.

Facial muscle (Source from Asian Plastic Surgery)

GetDoc: How would you describe your art sense?

Dr Steve: I love to go for natural results, without much dramatically changes. I would like to keep myself updated to the current trend, which is more natural result, not to change to patients’ original appearance to someone else. I would like to enhance patient’s existing feature to bring out the best version of themselves. And I believe the best result is subtle yet noticeable. Natural enough and still able to make an impact to the appearance.

GetDoc: What are the consequences of Botox and dermal filler performed by uncertified personnel?

Dr Steve: You have to look for certified aesthetic doctor for filler and Botox injection, so say NO to uncertified personnel. Doctors undergo many years of training to understand human anatomy and to perfect our skills in injection before we do treatments on our patients. Imagine if filler wrongly injected the blood vessel, or damages any important nerves, you may be facing a long term complication which may be irreversible. Besides the injection skill, medical products are only supplied to proper licensed medical clinic only, so its highly unlikely to acquire genuine and safe product from uncertified personnel or dodgy centers. I’ve heard of patient buying products directly of internet and claimed that they are genuine. In fact, they are not genuine.

GetDoc: Final questions, what general advice would you give to someone looking to get Botox?

Dr Steve: Botox is generally considered safe in a clinical setting. However there are different brands in the market, some are approved by our Ministry of Health, some are not. For those which are not approved, they are usually being used by beauticians, and sourced from China and Korean. So I advise patients to ask these questions with their doctors before going on any procedure:

Which brand of Botulinum toxin are they using?

Has the product obtained any FDA approval?

Has the brand they are using been approved by our Ministry of Health?

Can the doctor show the Before and After pictures of patients with the same treatment?

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by Qian

Qian's interest in healthcare industry came about after her father was diagnosed with bladder cancer. This experience has led her to become a strong believer in empowering individuals to take charge of their own health. View all articles by Qian.